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IM MedEd > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

> 50 yoa, Unilateral temporal HA, swollen tender temp. artery, Jaw Claudication, fever, elevated ESR, weight loss. dx? tx? assoc?

A

Giant cell temporal arteritis via biopsy

assoc: polymyalgia rheumatica
tx: steroids

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2
Q

<40fever, elevated ESR, weight loss, w/absent pulses. how to dx? tx?

A

takayasu arteritis, dx w/angiongram.

tx: prednisone

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3
Q

What is polymyalgia rheumatica? whats it assoc w/?

A

Giant Cell Temporal arteritis. inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders. worse in the morning. normal CK but elevated ESR.

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4
Q

Asian child, strawberry red tongue, truncal rash, palmer erythema, MI in kid. dx? tx?

A

Kawasaki

Tx: IVIG, ASA

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5
Q

Renal failure, mesenteric ischemia, purpura, painful nodules + Mononeuritis Multiplex. dx? tx? assoc?

A

PAN, assoc w/HEP B.

dx: angiogram
tx: steroids + cyclophos bc dz is so severe.

Mononeuritis Multiplex: motor +sensory deficits at periphery that come and go, painful + asymmetric

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6
Q

Pt w/hematuria, hemotysis + nasal problems. dx? assoc? tx?

A

Wegners = C-ANCA

dx: biopsy shows necrotizing granulomas
tx: steroids + cyclophos

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7
Q

Cryoglobinemia

A

assoc w/HEPC = palpable purpura + RF, elevated ESR + cryoglobins in serum along with decreased compliment

tx: steroids + Cyclophosphamide

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8
Q

Eosinophilic Polyangitis

dx? tx?

A

looks just like wegners w/PANCA & eosinophils on biopsy

tx: steroids + cyclo

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9
Q

Association ab dz: smith

A

lupus

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10
Q

Association ab dz: RF

A

RA

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11
Q

Association ab dz: CCP

A

RA

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12
Q

Association ab dz: Histone

A

drug induced lupus

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13
Q

Association ab dz: ds-DNA

A

lupus + renal

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14
Q

Association ab dz: mitochondrial

A

PBC

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15
Q

Association ab dz: JO

A

polymyositis

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16
Q

Association ab dz: Ro + La

A

Sjogren

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17
Q

Association ab dz: Topo(SCL70)

A

Systemic Scleroderma

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18
Q

Association ab dz: centromere

A

Scleroderma CREST

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19
Q

Association ab dz: smooth muscle

A

AI hepatitis

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20
Q

sx of lupus?

A

cerebritis(psycosis, ams), alopecia, malar/discoid rash, oral ulcers, libman-sacks endocarditis, arthralgias, renal failure, serositis(chest pain from lungs), 2nd trimester losses(hypercoagubility due to antiphospholipid syndrome)

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21
Q

Ab assoc w/ lupus nephritis?

A

ds-DNA ab

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22
Q

everyone with lupus gets….alternate?

A

Hydroxychloroquine > methotrexate

23
Q

tx of lupus flares/mild?

A

steroids

24
Q

tx of life threatening lupus nephritis or cerebritis?

A

IV cyclophosphamide then transition to Mycophenolate Mofetil PO

25
Q

Role of NSAIDs w/lupus?

A

tx arthralgias

26
Q

Pt with neck pain in the morning that last for about 2 hrs along with knee, wrist and general joint pain. Dx? Tx?

A

Rheumatoid arthritis

Tx: NSAIDs(supplemental) + DMARDs(methotrexate > leflunomide, hydroxychlorquine if prego) +biological(anti-TNF if severe) + steroids(flares)

27
Q

Tx of severe RA?

A

NSAIDs(supplemental) + DMARDs(methotrexate > leflunomide, hydroxychlorquine if prego) +biological(anti-TNF if severe) + steroids(flares)

28
Q

Tx of RA flare?

A

NSAIDs(supplemental) + DMARDs(methotrexate > leflunomide, hydroxychlorquine if prego) +biological(anti-TNF if severe) + steroids(flares)

29
Q

How to dx RA?

A
  1. Anti-RF(sensitive) & CCP(specific)
  2. Symmetric arthritis that involves three joints and spares the DIPs
  3. X-ray shows Periarticular osteopenia and marginal bony erosions
  4. Rheumatoid nodule biopsy shows cholesterol deposits
30
Q

What is the pathology of RA?

A

Auto immune disease resulting in pannus formation at the joint which leads to a erosion and bony destruction

31
Q

What would you see if you biopsied a rheumatoid nodule?

A

Cholesterol deposits

32
Q

What is the classic presentation of RA?

A

How long morning stiffness affecting many small joints that is symmetric. Morning stiffness last longer than 60 minutes and if it doesn’t go off the back will only affect the cervical spine. (Lower back=ankylosing spondylitis)

33
Q

Ai dx resulting in collagen replacing smooth muscle?

A

Scleroderma

34
Q

CREST scleroderma?

A

Calcinosis, Reynards, esophageal dysmotility, sclerodactyly, telangiectasias.

Assoc w/anti centromere an.

35
Q

Systemic scleroderma dx?

A

CREST + heart + renal

Assoc w/anti scl70

36
Q

How do you treat scleroderma?

A

Treat symptoms! Use calcium channel blocker’s for Reynards. Penicillamine for skin changes. Ace inhibitors for hypertension. And steroids for acute flare’s

37
Q

Pathology of Sjögren’s syndrome

A

Inflammation of. Exocrine glands do to lymphoplasmacytic infiltrate

38
Q

Symptoms of Sjogren’s

A

Dry eyes, dry mouth, bilateral parotid gland enlargement. Associated with ro and la antibodies

39
Q

How do you treat Sjogren’s syndrome

A

Symptom control with artificial tears and saliva

40
Q

Symptoms of polymyositis, dermatomyositis, inclusion body myositis

A

Painful proximal muscle weakness, heliotropic rash, photosensitivity, Groton’s papules

41
Q

How do you test for myositis?

A

You do EMG=electromyography to differentiate it from peripheral neuropathy

42
Q

Treatment of myositis and associated antibodies

A

Steroids!!! Jo and Mi

43
Q

Pt w/ 1 swollen joint. <50 wbcs and no gram stain on tap. Dx?

A

Crystal dz

44
Q

+birefringent crystals, rhomboid shape w/ calcium pyrophosphate. Dx? Tx?

A

NSAIDs or Colchine

45
Q

-birefringent crystals, needle shaped, mono sodium irate, podagra. Dx? To?

A

Gout!

If due to:
1. Tumor lysis syndrome: PPx: IVF + probenecid + allopurinol Tx: rasburicase

  1. Decrease excretion(diuretics,age,etoh,ckd) Tx: NSAIDS or Colchicine if no change add steroids +dirt &if refract allopurinol
46
Q

Hot tender, swollen join w/ >50 WBCs and somthing on gram stain dx?

A

Septic joint!

47
Q

Pt w/ >50 WBCs one joint tap w/ gram+cocci in clusters. Dx? Tx?

A

Staph! Usually due to trauma, IVDA or endocarditis

To: vanc vs nafcillin

48
Q

Pt w/ >50 WBCs one joint tap w/ gram-cocci in chains, urethritis, cerivicitis, tenosynovial rash. Dx? Tx?

A

Gonorrhea! To: ceftriax and doxy(chlam)

49
Q

HLA B27 associated spondyoarthropathies

A

PAIR = Psoriatic Arthritis, Ankylosing Spondylitis, IBD-Assoc Arthritis, Reactive Arthritis

50
Q

pt w/urethrits who now has asymmetric bilateral arthritis of the lower back and hands and conjunctivits. dx? tx?

A

Reactive Arthritis = usually do to chalymidia

tx: cause! = doxy + NSAIDs

51
Q

27 yo dude w/lower back pain + morning stiffness that improves w/use. +stiffness in his right ankle. dx? assoc? tx?

A

Ankylosing Spondylitis = men 20-30 w/calcifications of joints + tendons(achilies mc) = bamboo spine on xray.

  • associated w/UC
  • inflammation at ligamentous insertions
    tx: NSAIDs > Methotrexate > Etanercept(TNF inhib)
52
Q

Pt w/IBD and now has arthritis in his back. You treat the patient for his IBD and arthritis goes away. dx?

A

IBD-associated arthritis/Enteropathic

*may also involve other joints!

53
Q

Pt w/IBD and now has arthritis in his back. You treat the patient for his IBD and arthritis doesnt goes away. dx?

A

Ankylosing Spondylitis! the person prob has UC!

IM MedEd (24 decks)

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